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Deinstitutionalization Leads To Suicide Rise

Ruzanna Harutyunyan's picture

Reducing the number of beds available in public psychiatric hospitals is associated with increased suicide rates — and community-based mental health care is often not funded at a level sufficient to help. A new study finds that for every bed lost for 100,000 people in the population, 45 additional suicides would occur per year.

“The expansion of the community mental health system has not been able to successfully integrate persons with severe mental disorders and thereby couldn’t replace public bed reductions,” said study author Jangho Yoon, Ph.D., at the University of California School of Public Health, in Berkeley.

The study appears online in the journal Health Services Research.

Ronald Manderscheid, Ph.D., is the director of Mental Health and Substance Use Programs at SRA International, a research and consulting organization He says the study “covers the essential bases” to examine this relationship.

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Manderscheid, who is not affiliated with this research, said it does not undermine the idea that mentally ill people can be safely served in the community.

“There’s no particular reason why most people with a mental health problem need a bed. They need good care. The idea of deinstitutionalization was wonderful, but its implementation was absolutely terrible,” he said, adding that cutting state hospital funding “became a vehicle to save money, not to improve care.”

Yoon’s research also found that if spending on community-based services goes above a certain level, reducing state hospital beds would not increase suicide. However, only Pennsylvania and Vermont fund community-based services above that level, which is $107 per capita in 2008 dollars.

The study also gives support to advocates of equal insurance coverage for mental and physical disorders. State laws mandating “parity” were linked with lower suicide rates. However, increased numbers of private psychiatric hospital beds did not make up for losses in state beds.

“In the psychiatric care market, there is evidence that for-profits disproportionately serve profitable patients with less severe symptoms,” Yoon said. Consequently, increased numbers of such beds do not help the most debilitated mentally ill people, who often are poor and do not have insurance.

Manderscheid said that the recession is having a drastic effect on mental health services overall, increasing the risks faced by the mentally ill. “The whole structure is eroding,” he said, “Not just ambulatory outpatient programs, but also hospitals, local not-for-profits and local community-based organizations. Private hospitals are also in trouble in many communities.”